The Work of COVID: care work and care home mortality

By Ishan Khurana, Lukas Kikuchi and Will Stronge

May 13 2020

New figures show that more care workers are dying due to COVID than workers in any other occupational category.

In our new study, we unpack the gender, ethnicity and working conditions of care workers.

Those living in care homes and those caring for them are at the eye of the COVID storm: without adequate testing and PPE, the situation will likely continue its grim course.

The current study also reveals the geographical spread of care home deaths across England and Wales, according to the latest ONS figures.

Autonomy’s ongoing analysis of available ONS data on all excess deaths during this COVID crisis has revealed key messages – and warnings – for government. With the current study, we have focused in on those who have arguably been worst hit by the COVID pandemic: those in care homes and the care workers who look after them.

New ONS figures have revealed that more care workers have died during this COVID pandemic than workers in any other occupational category. Though it appears that lockdown is helping stabilise the impacts of the virus, in various parts of the country – such as Trafford, Cheshire West and Chester – COVID care homes deaths have in fact increased in the final week of April (the date up to which data is available). This is occurring in a context of a serious and pressing lack of protective equipment for frontline staff.

Who are the care workers who work in these homes and under what conditions do they work?

+ More care workers have died than any other category of worker.

+ Men make up only 15% of all care workers, but make up 33% of COVID care worker deaths.

+ Average care worker pay is well below the recognised poverty line.

+ 35% of care workers are on 'zero-hour contracts'.

+ The majority of care workers are BAME in London, but in the UK overall 81% are white.

+ Excess care home deaths are broadly concentrated in the North but increases and decreases in mortalities per week vary from place to place.

Figure 1: COVID deaths by occupation in England and Wales

Source: Autonomy analysis of ONS data.

Figure 1 shows the number of COVID deaths across different occupations. More care workers (98) have died so far during this COVID pandemic in the UK than workers in any other occupational category.

Men make up only 15% of all care workers, but make up 33% of COVID care worker deaths – suggesting a similar trend wherein a higher proportion of men are dying due to COVID than women.

Figure 2: Care worker ethnicity in London (a) and across the UK (b)

Source: Autonomy analysis of ONS data. Ethnicity labels are those used by ONS.

In London, the majority of care workers are BAME, but in the UK overall 81% are white.

Although mortality data by both ethnicity and occupation (together) is unavailable, the high rate of COVID deaths in London would suggest that many of those care workers who have passed away were people of colour.

Figure 3: Care workers and the gender distribution

Source: Autonomy analysis of ONS data.

As Figure 3 shows, the vast majority of care workers are women and this correlates with the majority of care worker COVID deaths.

66 women care workers have died so far in this crisis, compared to 32 men.

Figure 4: Estimated number and proportion of workers in the adult social care sector on a zero-hours contract, by selected job roles, 2018/19

Source: Skills for Care.

Care workers in the adult social care sector are disproportionately working under zero-hour contracts – with 35% estimated to be employed on such terms.

In our Jobs at Risk Index, we noted that care workers are amongst the lowest paid of the UK workforce but scored highly on our Risk Indication Factor regarding COVID exposure. Care work involves a high level of physical proximity with others as well as relatively frequent encounters with diseases and other illnesses. The combined Risk Indication Factor (74) we found in the JARI study has since been grimly corroborated by the high levels of COVID deaths amongst care workers, compared to other professions.

Full-time average pay for care workers is £391 per week – with significant differences in pay between men and women. This is well below the poverty line (2/3 of the median average wage), meaning these workers are being paid poverty wages.

Figure 5: Weekly, excess deaths reported in care homes at the local authority level as reported up until 1st May

Enable zoom

In Figure 4 we have plotted the weekly excess deaths in care homes at the local authority level for England and Wales; these are the hazardous workplaces of care workers during this COVID crisis.

You can toggle different dates to see the differences between weeks spanning from April 3rd to May 1st.

If you would like to zoom in to inspect a particular local authority, toggle the zoom box and then scroll and hover your mouse over the location. By clicking through the dates, we can see the stark contrast – representing a significant increase in excess deaths – across the month of April.

Some local authorities saw increases in the weekly excess deaths in care homes

Between 24th April and 1st May, the number of care home COVID-related deaths in Cheshire West and Chester went up, from 18 to 26 (taking the tally to 66 since 3rd April). Since the start of April, care homes in Cheshire West and Chester are yet to see a decrease in COVID deaths. Care homes in St. Helens and West Oxfordshire have also seen continuous increases in COVID deaths (see Fig. 6).

Care home COVID-related deaths in Trafford doubled in the week between 24th April and 1st May – from 11 to 22.

Walsall also saw a marked increase, recording 11 COVID-related deaths in care homes in the w/e 24th April, but then as many as 23 by w/e 1st May.

Figure 6: Weekly, care home COVID deaths in various local authority in England and Wales

Source: Autonomy analysis of ONS data.

Other local authorities saw decreases in the weekly excess deaths in care homes

There was some good news in a number of local authorities, where excess (COVID) care home deaths decreased.

County Durham – one of the local authorities with the highest number of recorded deaths – reported a decreased in weekly deaths, with 37 deaths by w/e 1st Monday down from 49 recorded the previous week.

Liverpool reported 13 fewer deaths in the week ending 1st May compared with the previous week, with 18 deaths down from 31.

The excess deaths are likely an underestimate due to the weekly death rate in 2020 between February until the start of the crisis in March being 5.8 ± 1.4 % lower than the five year average weekly death rate for this time of year. This leads to an overestimation of the expected deaths and hence an underestimation in the excess deaths.